California Department of Managed Health Care orders PacifiCare of California to let its members remain with the Sequoia Network

Members unaware that doctors would not be available to them

(Sacramento) - The California Department of Managed Health Care (DMHC) has ordered PacifiCare of California to continue to authorize services and allow approximately 500 members access to doctors belonging to the Sequoia Directly Contracted Network through November 2007. The plan terminated the contract with Sequoia on May 1, 2007 but did not inform members when they renewed their insurance during open enrollment 2006, even though plan officials knew at the time that the doctors would not be part of its network.

“PacifiCare’s failure to disclose its planned termination of Sequoia to its members is dishonest and unfair,” said Amy Dobberteen, Chief of Enforcement for the DMHC. “We will not stand by while patients are deceived and not given adequate information to make an informed choice before they sign up for a health plan.”

According to official PacifiCare statements sent to the Sequoia doctors as early as 2005, PacifiCare planned to terminate the contracts. Local members complained to the DMHC that PacifiCare failed to notify members of its plan prior to the enrollment/re-enrollment period in the fall of 2006. Consequently the members were unaware that they would no longer be able to see their current doctor.

Deeming this practice deceptive and unfair, the DMHC has ordered PacifiCare to authorize services and continue to allow access to the Sequoia Directly Contracted Network for those members through November 2007.

For any PacifiCare members using Sequoia doctors, the HMO Help Center can help with any problems or questions that may arise. The 24-hour, 7-day a week HMO Help Center can be reached at 1-888-HMO-2219 or on the Web at www.hmohelp.ca.gov. The HMO Help Center can also assist all California consumers to resolve problems with HMOs such as prescriptions, office visits, or medical coverage.

The California Department of Managed Health Care is the only stand-alone HMO watchdog agency in the nation, touching the lives of more than 21 million HMO members. The DMHC educates consumers on health care rights and responsibilities, and has assisted nearly 805,729 Californians through its 24-hour HMO Help Center to resolve their HMO problems.